Gender differences in chronic liver diseases in two cohorts of 2001 and 2014 in Italy

Khadka

J. Nepalgunj Med. College

2018

Background: Majority of cirrhotic patients develop varices over their lifetime and it is anticipated that roughly one third of varices will develop bleeding. Child Turcotte Pugh (CTP) class predicts the risk of variceal bleeding and has been used as a prognostic tool inpatients of liver cirrhosis. Objective: To correlate grade of esophageal varices in Upper Gastrointestinal endoscopy with Child Turcotte Pugh class in patients of liver cirrhosis. Material and method: This is a cross sectional descriptive study conducted in thedepartment of medicine of NGMCTH, Kohalpur between December 2017 to November 2018. A total of 97 patients were included inthe study who were diagnosed as cirrhosis of liver clinically and radio logically. Patient were classified into CTP class A, B and According to CTP score. UGI endoscopy was performed and endoscopic grading of esophageal varices were correlated with CTP classand the data were recorded and analysed. Result: Mean of patients was 50 years. Among 97 patients, 30 (30.9%) were in CTP class A,30 (30.9%) in CTP class B and 37 (38.1%) were in CTP class C. 25 (25.8%) had small varices, 50 (51.5%) had large varices with red colorsign, 20 (20.6%) had large varices without red color sign and 2 (2.1%) had no varices. Most of the patients in CTP class B and C hadlarge varices with red color sign whereas CTP class A had small varices. Conclusion: The cirrhotic patients in CTP class B and C havelarge varices with red color sign and have more chances of bleeding. Hence, routine screening is indicated to determine the presenceof varices. Porphylactic therapy after identifying large varices will decrease the incidence of bleeding leading to reduction inmortality rate.

Section: Discussionsupporting

confidence: 80%

Correlation of Grading of Esophageal Varices with Child Turcotte Pugh Class in Patients of Liver Cirrhosis

Khadka

J. Nepalgunj Med. College

2018

Clinical Laboratory Analysis

“…In addition, the finding that females were significantly older than males might also refect a course in disease progression. Previous studies have shown that the liver fibrosis status of women changes with age, which may be due to changes in the reproductive status, providing some hints for the result. The study showed that male patients had different etiology distribution (hepatitis B, hepatitis C, and alcohol‐associated) and the etiologies were diversified.…”

Section: Discussionmentioning

confidence: 92%

“…18,19 In addition, the finding that females were significantly older than males might also refect a course in disease progression. Previous studies have shown that the liver fibrosis status of women changes with age, which may be due to changes in the reproductive status, 20 Therefore, less treatment measures will affect the prognosis of patients. We again recommend regular follow-up of patients with liver disease to improve early diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics analysis of 1180 patients with hepatocellular carcinoma secondary to hepatitis B, hepatitis C and alcoholic liver disease

Zhao

Zhu

Han

et al. 2019

Objective To determine the clinical and liver stiffness characteristics of a cohort of Chinese patients with Hepatocellular carcinoma in different stages of Barcelona clinic liver cancer. Methods Details of 1180 patients with Hepatocellular carcinoma referred from October 2014 to November 2017 were collected retrospectively. Demographic data, etiology, clinical, and biochemical details were retrospectively analyzed. The changes of liver stiffness in different etiologies and different stages of Barcelona clinic liver cancer were especially analyzed. Results The onset age was 60.33 ± 9.11 (range 24‐84) years, 9 cases were ≤40 years, 572 cases were 41‐60 years, males accounted for 83.92%, females accounted for 16.08%; 599 cases were ≥61 years, males accounted for 78.25%, females accounted for 21.75%. Compared with males, the proportion of females ≥61 is higher than that of men. Majority (n = 787; 66.69%) had HBV infection; second commonest cause was HCV infection (n = 217; 18.39%). More patients with HBV infection were 41‐60 years (69.06%) and were younger than HCV patients. There was no statistical difference in etiology, age, gender, and distribution of diabetes mellitus among different Barcelona clinic liver cancer stages (P > .05). The overall Hepatocellular carcinoma (HCC) was found to be positively correlated with alkaline phosphatase, γ‐glutamyltransferase, and alpha‐fetoprotein and liver stiffness measurement values from stage A to stage D (P < .05). ANOVA analysis showed that the overall liver stiffness measurement among the four BCLC stages was found to be statistically significant different in HBV‐infected and HCV‐infected HCC patients. Conclusion Majority (99.24%) were patients aged >40 years old. Male is a high incidence population. In etiological analysis, HBV dominates HCC occurrence, HBV‐, HCV‐, and alcohol‐associated HCC have distinct clinical and biochemical characteristics, necessitating different screening policies to optimize HCC surveillance and management.

“…A cohort study of over 12,000 patients showed that males with CLD were younger (52.9 vs. 58.7 yrs.) and additionally more frequently suffered from alcoholic liver disease (11.4% vs. 6.9%) than women with CLD [146]. Researchers of this analysis have highlighted significant gender differences in terms of the etiologic factors and the onset of chronic liver disease.…”

Section: Other Pathological Conditions and Hccmentioning

confidence: 93%

“…On this basis, it can be concluded that fibrosis as a consequence of CLD may also be gender-dependent. According to Saginelli et al [146] factors such as NF-κB, STAT3 and JNK could be linkers with the onset of HCC in patients with cirrhosis. In an inflammatory mouse model (mdr2 −/− mice with cholangitis, chronic liver inflammation and finally HCC), the TNF-NF-κB axis had a pro-carcinogenic effect on the liver.…”

Section: Other Pathological Conditions and Hccmentioning

confidence: 99%

Sex Hormone-Dependent Physiology and Diseases of Liver

Kur

Kolasa

Misiakiewicz-Has

et al. 2020

IJERPH

111

Sexual dimorphism is associated not only with somatic and behavioral differences between men and women, but also with physiological differences reflected in organ metabolism. Genes regulated by sex hormones differ in expression in various tissues, which is especially important in the case of liver metabolism, with the liver being a target organ for sex hormones as its cells express estrogen receptors (ERs: ERα, also known as ESR1 or NR3A; ERβ; GPER (G protein-coupled ER, also known as GPR 30)) and the androgen receptor (AR) in both men and women. Differences in sex hormone levels and sex hormone-specific gene expression are mentioned as some of the main variations in causes of the incidence of hepatic diseases; for example, hepatocellular carcinoma (HCC) is more common in men, while women have an increased risk of autoimmune liver disease and show more acute liver failure symptoms in alcoholic liver disease. In non-alcoholic fatty liver disease (NAFLD), the distinction is less pronounced, but increased incidences are suggested among men and postmenopausal women, probably due to an increased tendency towards visceral fat accumulation.